← Back to Search
Is There A Role For High Tibial Osteotomies In The Athlete?
Bryan A Warme, K. Aalderink, A. Amendola
Published 2011 · Medicine
Download PDFAnalyze on Scholarcy
Context: The use of high tibial osteotomies (HTOs) in elite and professional athletes has been slow to gain acceptance by both the athlete and the surgeon because it is generally thought that return to competitive sports will be unlikely. Conversely, HTOs have been used extensively and effectively in managing degenerative knee arthrosis in the less active recreational patient with varus deformity who wishes to maintain activity and delay the need for knee arthroplasty. Unfortunately, situations arise where elite athletes develop debilitating pain secondary to malalignment that prevents them from participation, at which time corrective osteotomy may be indicated. Return to sport is not necessarily the goal of osteotomy surgery, but success with correction may allow the athlete to return to high-level activity. Return to elite competition is not the singular goal of HTO in the athlete; however, if the surgery is successful, then consideration can be given to return to play. Evidence Acquisition: Despite an extensive literature on return to elite competition after many orthopaedic procedures, there are relatively few data following osteotomies. Results: With expanded indications, osteotomies have become increasingly popular in young patients with malalignment and arthrosis. In addition to addressing malalignment and degenerative processes, HTO can be used in elite athletes in combination with knee reconstructive procedures to address articular defects, meniscal deficiency, and instability, thereby optimizing knee function. Conclusion: When performed with the proper indications in competitive athletes, HTO can result in unloading of joint resurfacing procedures, pain reduction, increased functional stability, and restored joint mechanics. Furthermore, as performed in select elite athletes, HTO realignment may not only result in return to play but also improve function and possibly prolong competition at a high level.
This paper references
Chondral Resurfacing and High Tibial Osteotomy in the Varus Knee
W. Sterett (2004)
Microfracture of the hip in athletes.
Kevin Crawford (2006)
Accumulation of irrigation fluid in the calf as a complication during high tibial osteotomy combined with simultaneous arthroscopic anterior cruciate ligament reconstruction.
C. Marti (1999)
Proximal Tibial Osteotomy. A Subjective Outcome Study*†
J. Insall (1996)
Valgus high tibial osteotomy. Comparison between an Ilizarov and a Coventry wedge technique for the treatment of medial compartment osteoarthritis of the knee.
A. Adili (2002)
Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study.
P. Hernigou (1987)
High tibial osteotomy versus unicompartmental joint replacement in unicompartmental knee joint osteoarthritis: 7-10-year follow-up prospective randomised study.
C. Stukenborg-Colsman (2001)
Function after tibial osteotomy for medial gonarthrosis below aged 50 years.
S. Odenbring (1989)
The Effect of a Proximal Tibial Medial Opening Wedge Osteotomy on Posterolateral Knee Instability
R. LaPrade (2008)
Transplantation of viable meniscal allograft. Survivorship analysis and clinical outcome of one hundred cases.
P. Verdonk (2005)
Changes in osseous correction after proximal tibial osteotomy: radiostereometry of closed- and open-wedge osteotomy in 33 patients.
G. Magyar (1999)
Proximal tibial osteotomy. Factors that influence the duration of satisfactory function.
L. Matthews (1988)
High tibial osteotomy with a calibrated osteotomy guide, rigid internal fixation, and early motion: longterm follow-up
A Billings (2000)
For reprints and permissions queries, please visit SAGE's Web site at
Complications of closing wedge high tibial osteotomy
J. Tunggal (2009)
Osteotomy for treating knee osteoarthritis.
R. Brouwer (2007)
Proximal tibial osteotomy in patients who are fifty years old or less. A long-term follow-up study.
D. Holden (1988)
High tibial osteotomy with overcorrection of varus malalignment in medial gonarthrosis.
R. Myrnerts (1980)
Effects of Increasing Tibial Slope on the Biomechanics of the Knee
J. Robert Giffin (2004)
Evaluation of the mechanical properties of posterolateral structures and supporting posterolateral instability of the knee.
Form and function of bone
FS Kaplan (1994)
Results of surgical treatment for non-union after high tibial osteotomy in osteoarthritis of the knee.
B. Tjörnstrand (1978)
Open-wedge osteotomy by hemicallotasis or the closed-wedge technique for osteoarthritis of the knee. A randomised study of 50 operations.
G. Magyar (1999)
Improvement in gait one year after surgery for knee osteoarthrosis: a comparison between high tibial osteotomy and prosthetic replacement in a prospective randomized study.
L. Weidenhielm (1993)
Union of Medial Opening-Wedge High Tibial Osteotomy Using a Corticocancellous Proximal Tibial Wedge Allograft
Gerald N Yacobucci (2008)
Tibial osteotomy for the varus osteoarthritic knee.
P. Aglietti (1983)
Case Report Accumulation of Irrigation Fluid in the Calf as a Complication During High Tibial Osteotomy Combined With Simultaneous Arthroscopic Anterior Cruciate Ligament Reconstruction
C. Marti (1999)
Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu plate. A one-year randomised, controlled study.
R. Brouwer (2006)
Assessment of lower limb alignment: supine fluoroscopy compared with a standing full-length radiograph.
S. Sabharwal (2008)
Open-wedge osteotomy of the proximal tibia with hemicallotasis
E. Nakamura (2001)
Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared.
H. Dejour (1994)
Valgus high tibial osteotomy. A long-term follow-up study.
J. Rudan (1991)
Overview of Existing Cartilage Repair Technology
A. McNickle (2008)
Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length.
T. Dugdale (1992)
Patellar height and the inclination of the tibial plateau after high tibial osteotomy. The open versus the closed-wedge technique.
R. Brouwer (2005)
[High tibial osteotomy for the treatment of osteoarthritis of the knee].
Gong-lin Zhang (2008)
Effect of PEMF on the healing of human tibial osteotomies : a double blind study
G. Mammi (1993)
Proximal tibial varus osteotomy for osteoarthritis of the lateral compartment of the knee.
M. Coventry (1987)
The Install Award. Survivorship of the high tibial valgus osteotomy. A 10- to -22-year followup study.
D. Naudie (1999)
Upper tibial osteotomy for secondary osteoarthritis of the knee.
B. Morrey (1989)
Proximal tibial osteotomy. A critical long-term study of eighty-seven cases.
M. Coventry (1993)
Activity level and wear in total knee arthroplasty: a study of autopsy retrieved specimens.
C. Lavernia (2001)
Regeneration of degenerated articular cartilage after high tibial valgus osteotomy for medial compartmental osteoarthritis of the knee.
T. Koshino (2003)
Orthopaedic Care of the Aging Athlete
A. Chen (2005)
High Tibial Osteotomy with a Calibrated Osteotomy Guide, Rigid Internal Fixation, and Early Motion. Long-Term Follow-up*
A. Billings (2000)
High Tibial Osteotomy and Ligament Reconstruction for Varus Angulated Anterior Cruciate Ligament-Deficient Knees *
F. Noyes (2000)
High tibial osteotomy for varus gonarthrosis. A long-term follow-up study.
J. Insall (1984)
Nerve and vessel injuries during high tibial osteotomy combined with distal fibular osteotomy: a clinically relevant anatomic study
A. Georgoulis (1999)
High-Impact Athletics After Knee Articular Cartilage Repair: A Prospective Evaluation of the Microfracture Technique
B. Morrey (2008)
Does arthroscopic abrasion arthroplasty promote cartilage regeneration in osteoarthritic knees with eburnation? A prospective study of high tibial osteotomy with abrasion arthroplasty versus high tibial osteotomy alone.
S. Akizuki (1997)
Different surgical options for monocompartmental osteoarthritis of the knee: high tibial osteotomy versus unicompartmental knee arthroplasty versus total knee arthroplasty: indications, techniques, results, and controversies.
Michael A Mont (2004)
Arthroscopic débridement for osteoarthritis of the knee.
R. Aaron (2006)
Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees
J. Agneskirchner (2004)
Importance of Tibial Slope for Stability of the Posterior Cruciate Ligament—Deficient Knee
J. Robert Giffin (2007)
Opening Wedge High Tibial Osteotomy for Symptomatic Hyperextension-Varus Thrust
D. Naudie (2004)
[High tibial osteotomy for varus deformity of more than 20 degrees].
Semih Aydoğdu (1997)
Tibial osteotomy for osteoarthritis of the knee.
J. Jackson (1982)
Intra-articular injection of an autologous preparation rich in growth factors for the treatment of knee OA: a retrospective cohort study.
M. Sanchez (2008)
Sporting Activity after High Tibial Osteotomy for the Treatment of Medial Compartment Knee Osteoarthritis
G. Salzmann (2009)
Comparison of augmented and non-augmented anterior cruciate ligament reconstruction combined with high tibial osteotomy
G. Stutz (2005)
Time-dependent clinical and roentgenographical results of Coventry high tibial valgisation osteotomy
D. Bettin (2004)
Cartilage resurfacing: filling defects.
A. Gross (2003)
A system for grading articular cartilage lesions at arthroscopy
F. Noyes (1989)
High-Impact Athletics after Knee Articular Cartilage Repair
K. Mithoefer (2006)
Impact of osteoarthritis on sports careers.
B. Wolf (2005)
Radiological Assessment of Osteo-Arthrosis
J. H. Kellgren (1957)
Treatment of chondral defects in the patellofemoral joint.
A. Gomoll (2006)
Early complications after high tibial osteotomy: a comparison of two techniques.
M. V. D. van den Bekerom (2008)
For reprints and permissions queries, please visit SAGE's Web site at http
The incidence of thrombosis in high tibial osteotomies with and without the use of a tourniquet
T. Motycka (2000)
The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study.
J. Agneskirchner (2007)
Relationship of the common peroneal nerve and its branches to the head and neck of the fibula
W. Ryan (2003)
Open-wedge osteotomy of the proximal tibia with hemicallotasis.
E. Nakamura (2001)
Valgus high tibial osteotomy
A. Adili (2001)
Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies.
J. Brinkman (2008)
Osteochondral mosaicplasty for the treatment of focal chondral and osteochondral lesions of the knee and talus in the athlete. Rationale, indications, techniques, and results.
G. Kish (1999)
Role of High Tibial and Distal Femoral Osteotomies in the Treatment of Lateral-posterolateral and Medial Instabilities of the Knee
P. Phisitkul (2006)
Total knee arthroplasty following high tibial osteotomy for osteoarthritis.
A. Amendola (1989)
The electrical stimulation of tibial osteotomies. Double-blind study.
G. Mammi (1993)
Complications in high tibial (medial opening wedge) osteotomy
G. Spahn (2003)
High tibial osteotomy for varus deformity of more than 20 degrees [In French
S Aydogdu (1997)
Anterior cruciate ligament reconstruction combined with valgus tibial osteotomy (combined procedure)
A. Boss (2005)
Long-term clinical experience with fresh osteochondral allografts for articular knee defects in high demand patients
N. Shasha (2004)
Osteotomies around the knee for the young athlete with osteoarthritis.
M. Wolcott (2005)
Proximal Tibial Varus Osteotomy: Indications, Technique, and Five to Twenty-one-Year Results
R. Marti (2001)
High Tibial Osteotomy
D. C. Lee (2012)
This paper is referenced by
Return to sports after valgus osteotomy of the knee joint in patients with medial unicompartmental osteoarthritis
D. Saragaglia (2014)
Gait analysis following medial opening-wedge high tibial osteotomy
V. Morin (2017)
Prospective evaluation of a new plate fixator for valgus-producing medial open-wedge high tibial osteotomy
M. Cotic (2014)
Proximal Tibial Osteotomy in Patients with Varus Knee Deformity Using M-W Technique: Evaluation of Results
F. Bagheri (2017)
Physical Activity after High Tibial Osteotomy for Treatment of Medial Compartment Knee Osteoarthritis
de Carvalho Júnior Lh (2016)
Comparative Study of Clinical and Radiographic Outcomes of High Tibial Osteotomy in Patients with Kissing Lesions and Non-Kissing Lesions
O. Shon (2017)
High Tibial Osteotomy versus Unicompartmental Knee Arthroplasty for Medial Compartment Arthrosis with Kissing Lesions in Relatively Young Patients
S. M. Ryu (2018)
Osteochondral and Meniscal Allograft Transplantation in the Football (Soccer) Player
S. Görtz (2012)
High tibial osteotomy
D. Bonasia (2014)
High Rates of Return to Sports Activities and Work After Osteotomies Around the Knee: A Systematic Review and Meta-Analysis
Alexander Hoorntje (2017)
Reprise du sport après ostéotomies de valgisation sur arthrose fémoro-tibiale médiale : à propos d'une série continue de 83 patients
René-Christopher Rouchy (2014)
Return to sports rate after opening wedge high tibial osteotomy in athletes
Ryo Kanto (2020)
Sportfähigkeit nach kniegelenknaher Osteotomie
J. Paul (2017)
Analyse quantifiée de la marche et ostéotomie tibiale de valgisation d’ouverture médiale
V. Morin (2016)
Computer-Assisted Osteotomies for Genu Varum Deformity : Rationale, Surgical Technique, Outcome and Return to Sports
D. Saragaglia (2017)
Improving activities and satisfaction of younger osteoarthritis patients after knee arthroplasty and osteotomy: A patient tailored approach
Suzanne Witjes (2018)
A case series of lateral opening wedge high tibial osteotomy for valgus malalignment
B. Collins (2012)
Realignment osteotomy of the knee allows for return to work and sport activities in the young athletic population
S. Witjes (2018)
Eight respectively nine out of ten patients return to sport and work after distal femoral osteotomy
Alexander Hoorntje (2018)
Success of High Tibial Osteotomy in the United States Military
B. Waterman (2015)
Surgical Management of the Aging Athlete
S. DeFroda (2016)